In cardiac surgery blood vessel walls are opened by a vascular or aortic punch to provide an opening of suitable configuration for attachment of arteries or veins as required in carrying out a cardiac surgical procedure. Initially, a blood vessel wall is slit with a scalpel creating a small incision through the wall for insertion of a punch head. An aortic punch removes a small disc, of tissue from a blood vessel wall by withdrawing the punch head and surrounding tissue through a cutting die. The disc so removed is retained by the punch head while a corresponding hole remains in the blood vessel defining a suitable opening for attachment of vein or artery in continuing with a cardiac procedure.
A vascular punch of this kind is disclosed in my U.S. Pat. No. 5,192,294, which comprises a pistol-like housing for positioning and actuating a vascular punch in surgery. The '294 vascular punch is an integrated device in which tissue removal components and their actuating components are permanently assembled in the pistol-like housing for the duration of the useful life of the punch, whether reused or disposed of as title of the '294 patent suggests.
It is desirable in surgical practice that different configurations of aortic punch be available to meet the variable operating site conditions encountered in practice. With prior art devices such as the '294 patent, these desirable arrangements are meet only by keeping an inventory of integrated devices each with its own pistol grip and specific punch configuration. It is also desirable to meet the requirements of endoscopic surgery particularly constraints involved in using a trocar for passing instruments to a surgical site.
There is need for an arrangement in which a common pistol grip or other handle configuration is suitable for a variety of punch configurations selected to meet specific operating site constraints of cardiac surgery.